Surgical approaches for total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Surgical Anatomy

Background:

• Surgical approaches for knee joint access aim to optimize pathology visualization while preserving critical surrounding structures.
• The medial parapatellar arthrotomy (anteromedial approach) is the traditional standard for total knee arthroplasty (TKA), offering broad joint exposure.
• Concerns regarding potential compromise of patellar circulation with the standard approach have led to the investigation of alternative medial and lateral surgical techniques.

Purpose of the Study:

• To review and discuss the various surgical approaches for knee joint exposure, particularly in the context of total knee arthroplasty (TKA).
• To highlight the ongoing controversy surrounding the optimal surgical approach for TKA.
• To evaluate the advantages and disadvantages of different arthrotomy techniques for knee surgery.

Main Methods:

• Literature review of established and alternative surgical approaches for knee joint access.
• Comparative analysis of exposure capabilities and potential risks associated with different arthrotomies.
• Discussion of clinical scenarios influencing arthrotomy selection for TKA.

Main Results:

• The anteromedial approach provides extensive exposure, beneficial for TKA, ligament reconstruction, and fracture fixation.
• Alternative medial approaches (subvastus, midvastus, trivector) and the anterolateral approach are discussed as potential alternatives to the standard anteromedial approach.
• Adequate anterior knee joint exposure for TKA can be achieved through careful planning and selection of various arthrotomy techniques.

Conclusions:

• The choice of surgical approach for TKA requires careful consideration of the specific clinical scenario.
• While the anteromedial approach is standard, alternative techniques may offer benefits in specific situations, potentially mitigating risks like compromised patellar circulation.
• Optimal arthrotomy selection is crucial for successful TKA outcomes, balancing exposure with the preservation of surrounding knee structures.